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A KFF Health News report describes rising use of multiple medications among older adults and the risk that drugs prescribed by different clinicians may interact or cause side effects. Experts say patients can ask a doctor or pharmacist to review their medicines and discuss whether any can be reduced safely; they caution against stopping medication without professional guidance.
A KFF Health News report is drawing attention to the risks older adults can face when taking several medications, including interactions and side effects, and urges patients with concerns to ask their clinicians for a review. The report describes a Pennsylvania man whose liver was affected by an interaction between his medications; his liver and kidney function returned to normal after he changed medications, according to the account.
The report identifies polypharmacy—taking five or more medications—as an increasingly common concern among older adults. A study published in JAMA Internal Medicine found that the share of Americans over 65 taking at least five medications nearly doubled between 2000 and 2020. The report says more than a third of older adults now take five or more medications a day.
Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University, said she sees older patients taking an average of 16 medications, often prescribed by multiple clinicians and filled at multiple pharmacies. More medicines can mean more opportunities for interactions, she said, while side effects can also build up as prescriptions are added over time.
The report describes a prescribing cascade, in which a medication’s side effect is treated with another drug, potentially leading to further side effects and prescriptions. It recommends keeping an up-to-date list of prescriptions, vitamins and supplements and bringing it to appointments. Patients who notice a new symptom or suspect a side effect can raise the possibility of deprescribing—a clinician-guided reduction or discontinuation of medication—with their doctor or specialist.
Why Medication Reviews Matter
For patients seeing several clinicians, a complete medication review can help surface prescriptions that may interact or duplicate treatment. DeLon Canterbury, a pharmacist and chief executive of GeriatRx, told KFF Health News that clinicians may not have access to one another’s records, particularly when they work in separate health systems. Patients should not assume that one clinician or a pharmacy has reviewed every medication they take.
The concern is not that all medications are unnecessary or unsafe. Medicines can play an important role in treating disease and supporting longer lives, as Canterbury said. The practical issue is whether each medicine remains appropriate for a particular patient, especially as health conditions change and the body processes drugs differently with age. A review can help patients and clinicians weigh potential benefits against side effects without treating medication reduction as a goal in itself.
The report also notes a policy development: the Centers for Medicare & Medicaid Services issued guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and helping patients taper when appropriate. That may address uncertainty among clinicians about reimbursement for work that can take time, although the report does not establish how widely the guidance will change practice.
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How Multiple Prescriptions Accumulate
Medication lists can grow gradually. A drug is prescribed for one condition, a side effect appears, and a second medication is added to address it. Mixon offered the example of a patient with heart failure taking a water pill to reduce fluid retention: increased urination may contribute to incontinence, which could then be treated with another prescription. The example illustrates a possible cascade, not a claim that every patient taking a water pill will need another drug.
Jonathan Bledsoe, a Marine veteran from Reading, Pennsylvania, told the report he had taken a medication to stabilize his mood and another to control cholesterol, along with other medicines. He said his urine turned dark, prompting him to contact his doctors. According to the report, he learned that an interaction was beginning to damage his liver; after changing medications, his liver and kidney function returned to normal.
Deprescribing has gained attention over the past decade alongside increased concern about polypharmacy, the report says. Canterbury said safe tapering is a relatively newer area of medical education and is not widely taught in medical schools. Any reduction needs to be considered with a clinician; the report does not recommend patients stop or change prescriptions on their own.
“As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases.”
— Amanda Mixon, a Vanderbilt University hospitalist and associate professor of bioinformatics
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What the Report Does Not Establish
The report does not quantify how many medication-related harms are caused by interactions, nor does the cited rise in polypharmacy establish that every person taking five or more drugs faces a harmful interaction. It also does not provide a breakdown of which medications or combinations account for the greatest risk.
It is not clear how many patients will receive medication reviews under the new CMS guidance or how the guidance will affect access to deprescribing services. The report also does not specify a single tapering method: whether and how to reduce a medicine depends on the medication and the patient’s circumstances. Readers should discuss concerns with a qualified clinician rather than stop a prescription abruptly.
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Bring the Full List to Clinicians
Patients concerned about a new symptom, a possible side effect or the number of medicines they take can bring an updated list to a primary care clinician, specialist or pharmacist and ask for a review. The list should include prescriptions, over-the-counter medicines, vitamins and supplements, as well as the doses when known. The report says a paper list can work as well as an app or other tracking tool.
Clinicians can then discuss whether each medicine is still needed and whether any change is appropriate. If a medication is to be reduced, the patient and clinician can plan how to do so safely and monitor for changes. How broadly medication reviews and tapering support will be used under the CMS guidance remains to be seen.
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Key Questions
What does polypharmacy mean in this report?
Polypharmacy refers here to taking five or more medications. The cited study found that the share of Americans over 65 taking that many nearly doubled from 2000 to 2020.
What is deprescribing?
Deprescribing is the planned reduction or discontinuation of a medication when a clinician determines that change may be appropriate. The report describes it as a process to discuss with a doctor or specialist, not a reason to stop a medicine without guidance.
What should I bring to a medication review?
Bring an up-to-date list of prescriptions, over-the-counter medicines, vitamins and supplements. Include doses if available, and share the list with each clinician involved in your care.
Does taking five or more medications mean a person should stop one?
No. The report does not say that every person taking five or more medicines should reduce them. A clinician can review whether each medication remains appropriate and discuss any potential change based on the patient’s situation.
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